Brain Imaging Changes Associated With Risk Factors for Cardiovascular and Cerebrovascular Disease in Asymptomatic Patients

Abstract

Reviews of imaging studies assessing the brain effects of vascular risk factors typically include a substantial number of studies with subjects with a history of symptomatic cardiovascular or cerebrovascular disease and/or events, limiting our ability to disentangle the primary brain effects of vascular risk factors from those of resulting brain and cardiac damage. The objective of this study was to perform a systematic review of brain changes from imaging studies in patients with vascular risk factors but without clinically manifest cardiovascular or cerebrovascular disease or events. The 77 studies included in this review demonstrate that in persons without symptomatic cardiovascular, cerebrovascular, or peripheral vascular disease, the vascular risk factors of hypertension, diabetes mellitus, obesity, hyperlipidemia, and smoking are all independently associated with brain imaging changes before the clinical manifestation of cardiovascular or cerebrovascular disease. We conclude that the identification of brain changes associated with vascular risk factors, before the manifestation of clinically significant cerebrovascular damage, presents a window of opportunity wherein adequate treatment of these modifiable vascular risk factors may prevent the development of irreversible deleterious brain changes and potentially alter patients' clinical course.

White Matter Microstructure Improves Stroke Risk Prediction in the General Population

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Tumor Necrosis Factor/Sphingosine-1-Phosphate Signaling Augments Resistance Artery Myogenic Tone in Diabetes

“…Supporting this premise, the present investigation identifies two vascular beds that are highly sensitive to impaired glucose control. Although the observed functional changes do not overtly perturb systemic hemodynamics or cerebral perfusion, they should not be underestimated: microvascular complications in diabetes are often asymptomatic during their early stages; once symptoms develop, they are generally difficult to reverse or clinically manage (32)(33)(34). Consequently, silent or asymptomatic microcirculatory dysfunction is now viewed as a key intervention point that can potentially alter the patient's clinical course.…”

Sex hormones and brain volumes in a longitudinal study of middle‐aged men in the CARDIA study

“…Based on their associations with brain volumes and/or hormonal measures (Bain, 2010; Caldwell & Jirikowski, 2009; Friedman et al., 2014) in the literature and/or in our sample, several covariates were included in the analyses: age, race (black/white), educational attainment (≤high school, >high school), total intracranial volume, body mass index, smoking status (never‐smoker, ex‐smoker, current smoker), hypercholesterolemia (total cholesterol ≥ 240 mg/dl and/or use of cholesterol lowering medication), fasting insulin measures (uU/ml), APOE‐e4 genotype (e4‐allele carriers, noncarriers) and medical history of: depressive symptoms (current or prior Center for Epidemiologic Studies‐Depression CES‐D score ≥ 16 and/or use of medication for depression), hypertension (current or prior diastolic blood pressure ≥ 90 and/or systolic blood pressure ≥ 140 and/or taking antihypertensive medication), vascular disorders (self‐reported occurrence of: heart attack, angina, heart failure, rheumatic heart disease, mitral valve prolapse, stroke and peripheral vascular disease), and diabetes mellitus status (current or prior diabetes defined following ADA criteria for levels of fasting, nonfasting or postprandial oral glucose tolerance test (OGTT) results, Hemoglobin A1c (HbA1c) percent, or use of antidiabetes medication). We used the Year 25 values of these covariates as most represented their history/cumulative values which potentially occurred in parallel to the sex hormone exposures of interest.…”